Occipitomental (Waters' view) radiographs from general practice: are they adequate?

Critics maintain that family physicians produce radiographic images of poorer technical quality than radiologists but the impact of lower quality images on patient care is unknown. Two radiologists assessed occipitomental radiographs made in either a general practice or a certified laboratory for 247 patients with clinically diagnosed acute bacterial rhinosinusitis. With an occipitomental radiograph correct positioning is more difficult than with the usual radiographs of chest or extremities commonly made in general practice. Good positioning was less common in radiographs from general practices, with the pyramid projected below the maxillary sinuses in 63% of radiographs from general practice and 79% of radiographs from a certified laboratory. However, a radiographic diagnosis of possible acute maxillary sinusitis was as common in radiographs from general practice (38%) as in radiographs from a certified laboratory (41%). Although routine use is not recommended, family physicians with suitable technical and interpretative skills can use an occipitomental radiograph to rule out acute maxillary sinusitis in difficult cases. With a radiograph that is hard to read the physician should act as if the disease is present or refer the radiograph to a consulting radiologist.